Purpose: To report a case of orbital emphysema and pneumocephalus after exposure to compressed air. Case summary: A 49-year-old male visited our medical center after his left eye was damaged by a compressed air gun in an industrial setting. During the anterior segment examination, swelling of the left periorbital area, crepitation, and tenderness were observed in the upper and lower eyelids. On slit-lamp examination, there was a 12 mm conjunctival laceration in the temporal area, subconjunctival hemorrhage, multiple subconjunctival air bubbles, and microhyphema in the anterior chamber. A computed tomography scan of the head and orbit showed subcutaneous and intraorbital emphysema and pneumocephalus. Primary closure of the lacerated conjunctiva was performed. The patient was prescribed systemic and topical antibiotics with bed rest. Four days after the trauma, microhyphema and swelling of the eyelids were decreased significantly. Six days after the trauma, there were improvements of orbital emphysema and pneumocephalus without any complications. In summary, we report a rare case of orbital emphysema and pneumocephalus caused by compressed air. Conclusions: Orbital emphysema and pneumocephalus can occur due to compressed air injury in the absence of orbital wall fracture.
